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Original article
peer-reviewed

Use of Laparoscopic Modified Nerve-Sparing Radical Hysterectomy for the Treatment of Extensive Endometriosis



Abstract

INTRODUCTION:  Endometriosis is an estrogen-dependent chronic inflammatory condition affecting 6-10% of reproductive-aged women.  Chronic pelvic pain impacts the quality of life of patients with endometriosis. Here, we describe the use of laparoscopic modified radical hysterectomy for the treatment of extensive and deeply infiltrating endometriosis.

METHODS: A retrospective chart review was conducted on patients with Stage IV endometriosis who underwent laparoscopic modified radical hysterectomy. All patients had a history of extensive endometriosis that failed medical and conservative surgical treatment and caused significant recurrent symptoms.  The objective of this study is to show the feasibility of treatment of Stage IV endometriosis by laparoscopic modified radical hysterectomy.

RESULTS: A total of 52 patients underwent laparoscopic modified nerve-sparing radical hysterectomy for endometriosis between October 2006 and September 2013. The most common preoperative symptom was chronic pelvic pain. Adjunctive procedures, including salpingo-oophorectomy, appendectomy, disc excision of the bowel and ureteroneocystostomy, and in one case bowel resection, were performed as indicated. Mean patient age was 44 years (range 32-55). Mean hospital stay was one day (range 0-3). Postoperative complications included one case of urinary retention, one vaginal cuff abscess, and one infected ureteral stent. Mean follow-up was 33 months (range 13-65). Out of 52 patients, 33 had at least one prior surgery for the treatment of endometriosis.  All patients reported dramatic pain relief, and there were no reports of symptom recurrence.

CONCLUSION: In cases of severe endometriosis, the use of laparoscopic modified nerve-sparing radical hysterectomy is a feasible and effective method for achieving long-term improvement in pain symptoms.  There was no difference noted between symptom recurrences in the group of patients with bilateral salpingo-oophorectomy versus those with ovarian conservation in contrast to prior studies.  Of note, 14 patients underwent bilateral oophorectomy, nine patients underwent unilateral oophorectomy, and two patients underwent removal of ovarian remnant.



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Original article
peer-reviewed

Use of Laparoscopic Modified Nerve-Sparing Radical Hysterectomy for the Treatment of Extensive Endometriosis


Author Information

Camran Nezhat Corresponding Author

Center For Special Minimally Invasive Surgery, Stanford University School of Medicine

James Xie

Stanford University School of Medicine

Diana Aldape

Center for Special Minimally Invasive and Robotic Surgery, Stanford University School of Medicine

Louise P. King

BIDMC, Harvard Medical School

Rugeen Rose Soliemannjad

Center for Special Minimally Invasive and Robotic Surgery, Stanford University School of Medicine

Erika Balassiano

Center for Special Minimally Invasive and Robotic Surgery, Stanford University School of Medicine

Farr Nezhat

St. Luke’s and Roosevelt Hospitals, St. Luke’s and Roosevelt Hospitals


Ethics Statement and Conflict of Interest Disclosures

Human subjects: This study did not involve human participants or tissue. Animal subjects: This study did not involve animal subjects or tissue. Conflicts of interest: The authors have declared the following conflicts of interest: Financial relationships: We declare(s) a grant from Johnson & Johnson. We declare(s) a grant from Storz. We declare(s) a grant from Intuitive Surgical. We declare(s) a grant from Stryker.


Original article
peer-reviewed

Use of Laparoscopic Modified Nerve-Sparing Radical Hysterectomy for the Treatment of Extensive Endometriosis


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Original article
peer-reviewed

Use of Laparoscopic Modified Nerve-Sparing Radical Hysterectomy for the Treatment of Extensive Endometriosis

  • Author Information
    Camran Nezhat Corresponding Author

    Center For Special Minimally Invasive Surgery, Stanford University School of Medicine

    James Xie

    Stanford University School of Medicine

    Diana Aldape

    Center for Special Minimally Invasive and Robotic Surgery, Stanford University School of Medicine

    Louise P. King

    BIDMC, Harvard Medical School

    Rugeen Rose Soliemannjad

    Center for Special Minimally Invasive and Robotic Surgery, Stanford University School of Medicine

    Erika Balassiano

    Center for Special Minimally Invasive and Robotic Surgery, Stanford University School of Medicine

    Farr Nezhat

    St. Luke’s and Roosevelt Hospitals, St. Luke’s and Roosevelt Hospitals


    Ethics Statement and Conflict of Interest Disclosures

    Human subjects: This study did not involve human participants or tissue. Animal subjects: This study did not involve animal subjects or tissue. Conflicts of interest: The authors have declared the following conflicts of interest: Financial relationships: We declare(s) a grant from Johnson & Johnson. We declare(s) a grant from Storz. We declare(s) a grant from Intuitive Surgical. We declare(s) a grant from Stryker.

    Acknowledgements


    Article Information

    Published: January 29, 2014

    DOI

    10.7759/cureus.159

    Cite this article as:

    Nezhat C, Xie J, Aldape D, et al. (January 29, 2014) Use of Laparoscopic Modified Nerve-Sparing Radical Hysterectomy for the Treatment of Extensive Endometriosis. Cureus 6(1): e159. doi:10.7759/cureus.159

    Publication history

    Received by Cureus: January 10, 2014
    Peer review began: January 11, 2014
    Published: January 29, 2014

    Copyright

    © Copyright 2014
    Nezhat et al. This is an open access article distributed under the terms of the Creative Commons Attribution License CC-BY 3.0., which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

    License

    This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Abstract

INTRODUCTION:  Endometriosis is an estrogen-dependent chronic inflammatory condition affecting 6-10% of reproductive-aged women.  Chronic pelvic pain impacts the quality of life of patients with endometriosis. Here, we describe the use of laparoscopic modified radical hysterectomy for the treatment of extensive and deeply infiltrating endometriosis.

METHODS: A retrospective chart review was conducted on patients with Stage IV endometriosis who underwent laparoscopic modified radical hysterectomy. All patients had a history of extensive endometriosis that failed medical and conservative surgical treatment and caused significant recurrent symptoms.  The objective of this study is to show the feasibility of treatment of Stage IV endometriosis by laparoscopic modified radical hysterectomy.

RESULTS: A total of 52 patients underwent laparoscopic modified nerve-sparing radical hysterectomy for endometriosis between October 2006 and September 2013. The most common preoperative symptom was chronic pelvic pain. Adjunctive procedures, including salpingo-oophorectomy, appendectomy, disc excision of the bowel and ureteroneocystostomy, and in one case bowel resection, were performed as indicated. Mean patient age was 44 years (range 32-55). Mean hospital stay was one day (range 0-3). Postoperative complications included one case of urinary retention, one vaginal cuff abscess, and one infected ureteral stent. Mean follow-up was 33 months (range 13-65). Out of 52 patients, 33 had at least one prior surgery for the treatment of endometriosis.  All patients reported dramatic pain relief, and there were no reports of symptom recurrence.

CONCLUSION: In cases of severe endometriosis, the use of laparoscopic modified nerve-sparing radical hysterectomy is a feasible and effective method for achieving long-term improvement in pain symptoms.  There was no difference noted between symptom recurrences in the group of patients with bilateral salpingo-oophorectomy versus those with ovarian conservation in contrast to prior studies.  Of note, 14 patients underwent bilateral oophorectomy, nine patients underwent unilateral oophorectomy, and two patients underwent removal of ovarian remnant.



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Camran Nezhat, M.D.

Center For Special Minimally Invasive Surgery, Stanford University School of Medicine

For correspondence:
nezhatinstitute@gmail.com

James Xie

Stanford University School of Medicine

Diana Aldape

Center for Special Minimally Invasive and Robotic Surgery, Stanford University School of Medicine

Louise P. King

BIDMC, Harvard Medical School

Rugeen Rose Soliemannjad

Center for Special Minimally Invasive and Robotic Surgery, Stanford University School of Medicine

Erika Balassiano

Center for Special Minimally Invasive and Robotic Surgery, Stanford University School of Medicine

Farr Nezhat

St. Luke’s and Roosevelt Hospitals, St. Luke’s and Roosevelt Hospitals

Camran Nezhat, M.D.

Center For Special Minimally Invasive Surgery, Stanford University School of Medicine

For correspondence:
nezhatinstitute@gmail.com

James Xie

Stanford University School of Medicine

Diana Aldape

Center for Special Minimally Invasive and Robotic Surgery, Stanford University School of Medicine

Louise P. King

BIDMC, Harvard Medical School

Rugeen Rose Soliemannjad

Center for Special Minimally Invasive and Robotic Surgery, Stanford University School of Medicine

Erika Balassiano

Center for Special Minimally Invasive and Robotic Surgery, Stanford University School of Medicine

Farr Nezhat

St. Luke’s and Roosevelt Hospitals, St. Luke’s and Roosevelt Hospitals